Job Description
Job Description
Quality Management Coordinator
About us:
Solis Health Plans is a new kind of Medicare Advantage company. We provide solutions that are transparent, connected, and effective for both our members and providers. Solis was created with a desire to offer a more personalized experience throughout every stage of the healthcare journey. Our team consists of experts who take pride in delivering quality service. We foster a culture of collaboration and support, where success is shared, and every employee is valued.
Position is fully onsite: Monday-Friday from 8:00 am - 5:00 pm
Location: 9250 NW 36th St, Miami, FL 33178
Bilingual in English & Spanish is required
Full benefits package offered on the first day of the month following the date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match!
Our health plan membership has grown exponentially from-2,000 to over 15,000 members in the last year!
Join our winning Solis Team!
Position Summary:
This position is responsible for preparing and managing the notification of member inpatient events between the health plan and the member's primary care provider (PCP). The coordinator will access available internal and external data, prepare summary notification documents, distribute the notices to member's PCP, ensure notifications are received and facilitate appropriate & timely follow-up care. The coordinator will be responsible for Stars improvement by supporting HEDIS and Star program data gathering process, as well as completing member & provider outreach as needed. The position will report to the Director of HEDIS &_Star.
Essential Functions and Duties:
Responsible for formulating/implementing and executing all Star quality program processes, requests, workflows or policies as requested by management in a courteous and efficient manner, including offering a proactive approach to suggestions and recommendations
- Responsible for gathering inpatient event information from internal and external sources and preparing notifications to PCPs
- Distributing inpatient event notices to PCP offices
- Confirm receipt of notifications with PCP office Resolve notification distribution issues
- Coordinate with other teams as required, including Provider Relations, Utilization Management and Care Management
- Access HEDIS data repository or Ensure Data Solutions to continually monitor areas of improvement on HEDIS gap closure
- Create PowerPoint decks and other training material for internal & external meetings Develop, monitor and report performance for improvement activities
- Attend health plan Joint Operating Meetings (JOM) and other quality meetings
- Attend on-site medical group provider meetings regarding quality measures
- Additional duties as assigned
Minimum Job Requirements:
High School graduate or GED equivalent; College degree preferred Minimum two-years Qi experience working in a health plan or medical clinic environment conducting quality activities and/or medical record reviews
Willing to travel locally to provider offices
Skills and Abilities:
- Attention to detail and quick learner
- Excellent verbal, written communication and interpersonal skills
- Excellent organizational skills, ability to multitask and stay focused in a fast-paced environment
Preferred qualifications:
- 2+ years of college, in pursuance of a Bachelor's or Associate's degree in Health Care
Required Languages:
Bilingual English & Spanish and/or Creole